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General NPI Number Information
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NPI Number | 1790068633
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Entity Type | Individual
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Provider Name | ALLEN CHARLES GREEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 888 S. SAWBURG AVE.
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City | ALLIANCE
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State | OH
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Zip | 44601
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Country | US
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Telephone | 330-821-2218
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Fax | 330-821-2473
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Provider Business Mailing Address
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Address Line | P.O. BOX 3246 888 S. SAWBURG AVE.
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City | ALLIANCE
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State | OH
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Zip | 44601
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Country | US
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Telephone | 330-821-2718
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Fax | 330-821-2473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12870
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License Number State | OH
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